Today’s pearl highlights an excellent resource for managing poisoned patients.
Is metformin dialyzable?
The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was established to provide evidence-based recommendations for different toxins. Their website has many helpful resources, including all of their peer-reviewed publications. I will share recommendations for other individual poisons in future pearls.
For today, we’ll focus on metformin:
- Extracorporeal treatment (ECTR) is recommended in severe metformin poisoning
ECTR is indicated if ANY of the following conditions are present:
- Lactate concentration greater than 20 mmol/L
- pH ≤ 7.0
- Failure of standard supportive measures
- Decreased level of consciousness
Cessation of ECTR is indicated when:
- ECTR should be continued until the lactate concentration is less than 3 mmol/L
- pH > 7.35, at which time close monitoring is warranted to determine the need for additional ECTR courses
Choice of ECTR:
- Intermittent hemodialysis is preferred initially
- Continuous renal replacement therapies may be considered if hemodialysis is unavailable
- Repeat ECTR sessions may use hemodialysis or continuous renal replacement therapy